Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery
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Otolaryngol Head Neck Surg · Jul 2020
ReviewA Commentary on the Challenges of Telemedicine for Head and Neck Oncologic Patients during COVID-19.
The COVID-19 pandemic is an unprecedented and historic event that presents unique challenges to patient care to medical providers worldwide. The pandemic and the ensuing rapid changes to medical practice have particularly affected head and neck cancer surgeons and their patients. In an effort to balance the needs of our patients with the risks to patient and staff safety, we have been tasked with finding alternatives to the traditional office visit. In this commentary, we discuss how telemedicine can be incorporated into the head and neck surgery practice, the challenges that we have faced, and the dilemmas with which we have dealt in our efforts to fulfill the ongoing need for care of this unique patient population.
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Otolaryngol Head Neck Surg · Jul 2020
ReviewEffects of COVID-19 Pandemic on Otolaryngology Surgery in Italy: The Experience of Our University Hospital.
Otolaryngology and head and neck surgery underwent drastic changes during the COVID-19 pandemic. Since March 10, the first day of the lockdown in Italy, diagnostic and therapeutic procedures were limited to emergency and oncology cases, while outpatient procedures and clinical examinations were temporarily suspended to limit virus diffusion and to reallocate personnel into wards dedicated to COVID-19. In our otolaryngology unit, between March 10 and April 28, 2020, we performed 96 surgical procedures; they mainly consisted in diagnosis and treatment of malignant tumors of the head and neck (77%), management of acute upper airway obstruction in adults and children (14.7%), drainage of abscesses of the head and neck (6.2%), and treatment of nasal bone fractures (2.1%). When comparing these data with those of the same period in 2019 for emergency and oncology procedures, we noticed a drastic reduction of head and neck abscesses and nasal bone fractures, while oncology surgery remained stable.
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Otolaryngol Head Neck Surg · Jul 2020
ReviewSustaining Otolaryngology Services for the Long Haul during the COVID-19 Pandemic: Experience from a Tertiary Health System.
The impact of the COVID-19 pandemic has been far-reaching and has profoundly affected the practice of otolaryngology in an unprecedented way. In this commentary, we draw from our experience in the first 90 days of the pandemic and discuss a set of workflow measures, personal protection equipment protocols, and strategic goals that can provide a safe environment for patients and staff to continue managing a significant proportion of patients in the otolaryngology service during the pandemic.
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Otolaryngol Head Neck Surg · Jul 2020
ReviewA Surgical Safety Checklist for Performing Tracheotomy in Patients with Coronavirus Disease 19.
Performance of tracheotomy is a potential necessary step in the patient with coronavirus disease 19 (COVID-19) and prolonged mechanical ventilation. Due to viral aerosolization, tracheotomy carries a high risk of transmission of COVID-19 to the health care team performing the procedure. We share our institution's surgical safety checklist for performing tracheotomy in patients with COVID-19, including key modifications intended to mitigate risk to the surgical team.
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Otolaryngol Head Neck Surg · Jul 2020
ReviewAirway Management for Endoscopic Laryngotracheal Stenosis Surgery During COVID-19.
The novel coronavirus disease 2019 (COVID-19) pandemic presents unique challenges for surgical management of laryngotracheal stenosis. High viral concentrations in the upper aerodigestive tract, the ability of the virus to be transmitted by asymptomatic carriers and through aerosols, and the need for open airway access during laryngotracheal surgery create a high-risk situation for airway surgeons, anesthesiologists, and operating room personnel. While some surgical cases of laryngotracheal stenosis may be deferred, patients with significant airway obstruction or progressing symptoms often require urgent surgical intervention. We present best practices from our institutional experience for surgical management of laryngotracheal stenosis during this pandemic, including preoperative triage, intraoperative airway management, and personal protective measures.